Pathophysiology of Anorectal Disorders

肛门直肠疾病的病理生理学

• 批准号: 10452611
• 负责人: ADIL E. BHARUCHA
• 金额: $ 38.66万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10452611
• 关键词: Abdomen; Abdominal Muscles; Abnormal coordination; Address; Anus; Barium; Biofeedback Training; Chronic; Constipation; Controlled Clinical Trials; Data; Defecation; Defecography; Diagnosis; Diagnostic tests; Disease; Feces; Female; Floor; Fluoroscopy; Functional disorder; Grant; Human; Image; Impairment; Intestines; Knowledge; Lateral; Left; Magnetic Resonance Imaging; Manometry; Measurement; Measures; Motion; Muscle; Patient Care; Patients; Pelvic floor structure; Persons; Phase; Positioning Attribute; Preparation; Process; Randomized; Rectum; Relaxation; Resolution; Rest; Role; Symptoms; Test Result; Testing; Time; Valsalva Maneuver; Woman; abdominal wall; anorectal disorder; base; design; foot; improved; innovation; insight; male; men; multidisciplinary; preservation; pressure; prevent; rectal; sphincter ani muscle structure; symptomatic improvement; ultrasound

PROJECT SUMMARY/ABSTRACT Defecation is a viscerosomatic process that requires increased rectal pressure coordinated with anal sphincter and pelvic floor relaxation. Defecatory disorders (DD) are defined by symptoms and objective features of impaired defecation. Our understanding of normal and disordered defecation are derived either from measurements of pressures (high-resolution manometry [HRM]) or emptying (defecography, rectal balloon expulsion test), but never both. HRM is usually conducted in the left lateral position with an empty rectum. This may partly explain why the rectoanal gradient (rectal – anal pressure) during evacuation is negative, even in most asymptomatic people, which undermines our concept of the mechanisms of normal defecation. Among patients, results of these tests are often inconsistent, hindering the diagnosis of DD. Excessive straining and “maladaptive” pelvic floor contraction during defecation is implicated to cause DD. However, abdominal wall motion during defecation and its coordination with pelvic floor motion have not been studied in healthy people or those with DD. Finally, even in controlled clinical trials, pelvic floor biofeedback therapy, the cornerstone of managing DD, only benefits 60% of DD patients. This treatment is not widely available or reimbursable; therefore additional therapies are necessary. Each study is designed to improve patient care in humans. Specific Aim 1: Address fundamental gaps in our knowledge of the mechanisms of normal and disordered defecation and the diagnosis of DD: 1a) Redefine the phases of normal evacuation using manodefecography; 1b) Identify the primary causes of DD in men versus women. Recto anal pressures and evacuation will be measured with HRM, barium, and MR manodefecography in 120 male and female healthy controls and 120 male and female DD patients. Specific Aim 2: Role of abdominal wall motion in normal and disordered defecation: 2a) Evaluate abdominopelvic coordination during defecation in healthy and DD women; 2b) Evaluate abdominopelvic coordination during defecation before and after biofeedback therapy. Abdominal wall motion and rectoanal pressures will be evaluated at rest and during various maneuvers, including simulated evacuation, in 30 healthy women and 60 women with DD. Specific Aim 3: Incorporating these concepts to manage DD: 3a) To assess the effects of a footstool on recto- anal functions in DD; 3b) To assess the symptoms in DD. Recto anal pressures and emptying as well as bowel symptoms will be evaluated before and after 85 female DD patients are randomized to a footstool. A multi-disciplinary collaborative team will apply innovative approaches to address these hypotheses in a highly refined manner.

项目概要/摘要 排便是一个内脏过程，需要与肛门括约肌协调的直肠压力增加 和盆底松弛症（DD）是根据症状和客观特征来定义的。 我们对正常排便和排便障碍的理解源自以下任一方面。 压力测量（高分辨率测压法 [HRM]）或排空测量（排粪造影、直肠球囊测量） 排出测试），但 HRM 通常在空直肠的左侧卧位进行。 可以部分解释为什么在排便期间直肠肛门压力（直肠 - 肛门压力）为负值，即使在 大多数无症状的人，这破坏了我们对正常排便机制的概念。 对于患者来说，这些测试的结果往往不一致，妨碍了 DD 的诊断。 排便时“适应不良”的盆底收缩可能导致 DD。 尚未在健康人中研究排便时的运动及其与盆底运动的协调 最后，即使在对照临床试验中，盆底生物反馈疗法也是治疗的基石。 管理 DD，仅使 60% 的 DD 患者受益。这种治疗方法尚未广泛使用或可报销； 因此，需要额外的治疗。每项研究的目的都是为了改善人类患者的护理。 具体目标 1：解决我们对正常和无序机制的认识上的根本差距 排便和 DD 的诊断： 1a) 使用排便造影重新定义正常排便的阶段； 1b) 确定男性与女性 DD 的主要原因。 直肠肛门压力和排泄情况将在 120 年内通过 HRM、钡剂和 MR 排粪造影进行测量 男性和女性健康对照者以及 120 名男性和女性 DD 患者。 具体目标 2：腹部壁运动在正常和排便紊乱中的作用：2a) 评估 健康和 DD 女性排便时腹盆腔协调性；2b) 评估腹盆腔 生物反馈治疗前后排便时的协调。 将在休息时和各种动作期间评估腹壁运动和直肠压力， 包括 30 名健康女性和 60 名 DD 女性的模拟疏散。 具体目标 3：结合这些概念来管理 DD：3a) 评估脚凳对直肠的影响 DD 中的肛门功能；3b) 评估 DD 中的症状。 将在 85 名女性之前和之后评估直肠肛门压力和排空以及肠道症状 DD 患者被随机分配到脚凳上，多学科协作团队将应用创新技术。 以高度精确的方式解决这些假设的方法。